HF 3630

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; providing children's mental health grants; establishing
mental health service delivery and finance reform; modifying mental health case
management and rates; modifying general assistance medical care coverages;
amending Minnesota Statutes 2004, sections 245.465, by adding a subdivision;
246.54, subdivision 1, by adding a subdivision; 256B.0625, subdivision
20; 256B.0945, subdivisions 1, 4; 256B.69, subdivisions 5g, 5h; 256L.12,
subdivision 9a; Minnesota Statutes 2005 Supplement, sections 245.4874;
256D.03, subdivision 4; 256L.03, subdivision 1; 256L.035; proposing coding
for new law in Minnesota Statutes, chapters 245; 256B; repealing Minnesota
Statutes 2004, sections 245.465, subdivision 2; 256B.0945, subdivisions 5, 6,
7, 8, 9; 256B.83.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2004, section 245.465, is amended by adding a
subdivision to read:

new text begin Subd. 3. new text end

new text begin Mental health services already provided. new text end

new text begin For individuals who have
health care coverage, the county board is not responsible for providing mental health
services which are covered by the entity that administers the health care coverage.
new text end

Sec. 2.

new text begin [245.4682] MENTAL HEALTH SERVICE DELIVERY AND FINANCE
REFORM.
new text end

new text begin Subdivision 1. new text end

new text begin Policy. new text end

new text begin The commissioner of human services shall undertake a series
of reforms to improve the underlying structural, financing, and organizational problems
in Minnesota's mental health system with the goal of improving the availability, quality,
and accountability of mental health care within the state.
new text end

new text begin Subd. 2. new text end

new text begin General provisions. new text end

new text begin In the design and implementation of reforms to the
mental health system, the commissioner shall:
new text end

new text begin (1) consult with consumers, families, counties, tribes, advocates, providers, and
other stakeholders;
new text end

new text begin (2) report to the legislature and the state Mental Health Advisory Council by January
15, 2007, with any recommendations for amending statutes, including to update the role of
counties;
new text end

new text begin (3) ensure continuity of care for persons affected by these reforms including:
new text end

new text begin (i) ensuring client choice of provider by requiring broad provider networks;
new text end

new text begin (ii) allowing clients options to maintain previously established therapeutic
relationships; and
new text end

new text begin (iii) developing mechanisms to facilitate a smooth transition of service
responsibilities;
new text end

new text begin (4) provide accountability for the efficient and effective use of public and private
resources in achieving positive outcomes for consumers;
new text end

new text begin (5) ensure client access to applicable protections and appeals; and
new text end

new text begin (6) make budget transfers that do not increase the state share of costs to effectively
implement improvements to the mental health system and efficiently allocate state funds.
When making transfers necessary to implement movement of responsibility for clients
and services between counties and health care programs, the commissioner shall ensure
that any transfer of state grants to health care programs does not exceed the value of the
services being transferred for the latest 12-month period for which data is available. The
commissioner may make quarterly adjustments based on the availability of additional data
during the first four quarters after the transfers first occur.
new text end

new text begin Subd. 3. new text end

new text begin Regional projects for coordination of care. new text end

new text begin (a) Consistent with section
256B.69 and chapters 256D and 256L, the commissioner is authorized to solicit, approve,
and implement regional projects to demonstrate the integration of physical and mental
health services within prepaid health plans and their coordination with social services. The
commissioner, in consultation with consumers, families, and their representatives, shall:
new text end

new text begin (1) determine criteria for approving the regional projects and use those criteria to
solicit regional proposals for integrated service networks;
new text end

new text begin (2) require that each project be based on locally defined partnerships that include
at least one health maintenance organization, community integrated service network, or
accountable provider network authorized and operating under chapter 62D, 62N, or 62T,
or county-based purchasing entity under section 256B.692 that is eligible to contract with
the commissioner as a prepaid health plan, and the county or counties within the region;
new text end

new text begin (3) waive any administrative rule not consistent with the implementation of the
regional projects; and
new text end

new text begin (4) begin implementation of the regional projects no earlier than January 1, 2008.
new text end

new text begin (b) Notwithstanding any statute or administrative rule to the contrary, the
commissioner shall enroll all medical assistance eligible persons with serious and
persistent mental illness or severe emotional disturbance in the prepaid plan of their choice
within the project region unless:
new text end

new text begin (1) they have no other basis for exclusion from the prepaid plan under section
256B.69, subdivision 4; or
new text end

new text begin (2) the individual has a previously established therapeutic relationship with a
provider who is not included in the available prepaid plans.
new text end

new text begin (c) If the person with serious and persistent mental illness or severe emotional
disturbance declines to choose a plan, the commissioner may preferentially assign
that person to the prepaid plan participating in the integrated service network. The
commissioner shall implement the enrollment changes within a regional project on the
timeline specified in that region's approved application.
new text end

new text begin (d) The commissioner, in consultation with consumers, families, and their
representatives, shall refine the design of the regional service integration projects and
expand the number of regions engaged in the demonstration projects as additional
qualified applicant partnerships present themselves.
new text end

new text begin (e) The commissioner shall apply for any federal waivers necessary to implement
these changes.
new text end

Sec. 3.

new text begin [245.4835] COUNTY MAINTENANCE OF EFFORT.
new text end

new text begin Subdivision 1. new text end

new text begin Required expenditures. new text end

new text begin Counties must maintain a level of
expenditures for mental health services under sections 245.461 to 245.484 and 245.487 to
245.4887 so that each year's county expenditures are at least equal to that county's average
expenditures for those services for calendar years 2004 and 2005. The commissioner will
adjust each county's base level for minimum expenditures in each year by the amount of
any increase or decrease in that county's state grants or other noncounty revenues for
mental health services under sections 245.461 to 245.484 and 245.487 to 245.4887.
new text end

new text begin Subd. 2. new text end

new text begin Failure to maintain expenditures. new text end

new text begin If a county does not comply with
subdivision 1, the commissioner shall require the county to develop a corrective action plan
according to a format and timeline established by the commissioner. If the commissioner
determines that a county has not developed an acceptable corrective action plan within
the required timeline, or that the county is not in compliance with an approved corrective
action plan, the protections provided to that county under section 245.485 do not apply.
new text end

new text begin new text end

Sec. 4.

Minnesota Statutes 2005 Supplement, section 245.4874, is amended to read:

245.4874 DUTIES OF COUNTY BOARD.

new text begin Subdivision 1. new text end

new text begin Duties of the county board. new text end

(a) The county board must:

(1) develop a system of affordable and locally available children's mental health
services according to sections 245.487 to 245.4887;

(2) establish a mechanism providing for interagency coordination as specified in
section 245.4875, subdivision 6;

(3) consider the assessment of unmet needs in the county as reported by the local
children's mental health advisory council under section 245.4875, subdivision 5, paragraph
(b), clause (3). The county shall provide, upon request of the local children's mental health
advisory council, readily available data to assist in the determination of unmet needs;

(4) assure that parents and providers in the county receive information about how to
gain access to services provided according to sections 245.487 to 245.4887;

(5) coordinate the delivery of children's mental health services with services
provided by social services, education, corrections, health, and vocational agencies to
improve the availability of mental health services to children and the cost-effectiveness of
their delivery;

(6) assure that mental health services delivered according to sections 245.487
to 245.4887 are delivered expeditiously and are appropriate to the child's diagnostic
assessment and individual treatment plan;

(7) provide the community with information about predictors and symptoms of
emotional disturbances and how to access children's mental health services according to
sections 245.4877 and 245.4878;

(8) provide for case management services to each child with severe emotional
disturbance according to sections 245.486; 245.4871, subdivisions 3 and 4; and 245.4881,
subdivisions 1, 3, and 5;

(9) provide for screening of each child under section 245.4885 upon admission
to a residential treatment facility, acute care hospital inpatient treatment, or informal
admission to a regional treatment center;

(10) prudently administer grants and purchase-of-service contracts that the county
board determines are necessary to fulfill its responsibilities under sections 245.487 to
245.4887;

(11) assure that mental health professionals, mental health practitioners, and case
managers employed by or under contract to the county to provide mental health services
are qualified under section 245.4871;

(12) assure that children's mental health services are coordinated with adult mental
health services specified in sections 245.461 to 245.486 so that a continuum of mental
health services is available to serve persons with mental illness, regardless of the person's
age;

(13) assure that culturally informed mental health consultants are used as necessary
to assist the county board in assessing and providing appropriate treatment for children of
cultural or racial minority heritage; and

(14) consistent with section 245.486, arrange for or provide a children's mental
health screening to a child receiving child protective services or a child in out-of-home
placement, a child for whom parental rights have been terminated, a child found to be
delinquent, and a child found to have committed a juvenile petty offense for the third or
subsequent time, unless a screening has been performed within the previous 180 days, or
the child is currently under the care of a mental health professional. The court or county
agency must notify a parent or guardian whose parental rights have not been terminated of
the potential mental health screening and the option to prevent the screening by notifying
the court or county agency in writing. The screening shall be conducted with a screening
instrument approved by the commissioner of human services according to criteria that
are updated and issued annually to ensure that approved screening instruments are valid
and useful for child welfare and juvenile justice populations, and shall be conducted
by a mental health practitioner as defined in section 245.4871, subdivision 26, or a
probation officer or local social services agency staff person who is trained in the use of
the screening instrument. Training in the use of the instrument shall include training in the
administration of the instrument, the interpretation of its validity given the child's current
circumstances, the state and federal data practices laws and confidentiality standards, the
parental consent requirement, and providing respect for families and cultural values.
If the screen indicates a need for assessment, the child's family, or if the family lacks
mental health insurance, the local social services agency, in consultation with the child's
family, shall have conducted a diagnostic assessment, including a functional assessment,
as defined in section 245.4871. The administration of the screening shall safeguard the
privacy of children receiving the screening and their families and shall comply with the
Minnesota Government Data Practices Act, chapter 13, and the federal Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191. Screening results shall be
considered private data and the commissioner shall not collect individual screening results.

(b) When the county board refers clients to providers of children's therapeutic
services and supports under section 256B.0943, the county board must clearly identify
the desired services components not covered under section 256B.0943 and identify the
reimbursement source for those requested services, the method of payment, and the
payment rate to the provider.

new text begin Subd. 2. new text end

new text begin Mental health services already provided. new text end

new text begin For individuals that have
health care coverage, the county board is not responsible for providing mental health
services which are covered by the entity which administers the health care coverage.
new text end

Sec. 5.

new text begin [245.4889] CHILDREN'S MENTAL HEALTH GRANTS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment and authority. new text end

new text begin The commissioner is authorized to
make grants from available appropriations to assist counties, Indian tribes, children's
collaboratives under section 124D.23 or 245.493, or mental health service providers in
providing services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families; and to young adults meeting the criteria for transition
services in section 245.4875, subdivision 8, and their families. Services must be designed
to help each child to function and remain with the child's family in the community and
delivered consistent with the child's treatment plan. Transition services to eligible young
adults must be designed to foster independent living in the community.
new text end

new text begin Subd. 2. new text end

new text begin Grant application and reporting requirements. new text end

new text begin To apply for a grant an
applicant organization shall submit an application and budget for the use of the money
in the form specified by the commissioner. The commissioner shall make grants only to
entities whose applications and budgets are approved by the commissioner. In awarding
grants, the commissioner shall give priority to those counties whose applications indicate
plans to collaborate in the development, funding, and delivery of services with other
agencies in the local system of care. The commissioner shall specify requirements for
reports, including quarterly fiscal reports, according to section 256.01, subdivision 2,
paragraph (q). The commissioner shall require collection of data and periodic reports that
the commissioner deems necessary to demonstrate the effectiveness of each service.
new text end

Sec. 6.

Minnesota Statutes 2004, section 246.54, subdivision 1, is amended to read:

Subdivision 1.

County portion for cost of care.

Except for chemical dependency
services provided under sections 254B.01 to 254B.09, the client's county shall pay to the
state of Minnesota a portion of the cost of care provided in a regional treatment center
or a state nursing facility to a client legally settled in that county. A county's payment
shall be made from the county's own sources of revenue and payments shall be paid as
follows: payments to the state from the county shall equal 20 percent of the cost of care, as
determined by the commissioner, for each deleted text begin day deleted text end new text begin of the first 60 days new text end , or the portion thereof,
that the client spends at a regional treatment center or a state nursing facility. new text begin After the
first 60 days, the county share is 50 percent. new text end If payments received by the state under
sections 246.50 to 246.53 exceed 80 percent of the cost of care new text begin for the first 60 days or 50
percent for any additional days new text end , the county shall be responsible for paying the state only
the remaining amount. The county shall not be entitled to reimbursement from the client,
the client's estate, or from the client's relatives, except as provided in section 246.53. deleted text begin No
such payments shall be made for any client who was last committed prior to July 1, 1947. deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007.
new text end

Sec. 7.

Minnesota Statutes 2004, section 246.54, is amended by adding a subdivision
to read:

new text begin Subd. 3. new text end

new text begin Additional exception for community behavioral health hospitals.
new text end

new text begin Subdivision 1 does not apply to services provided at state-operated community behavioral
health hospitals. For services at these facilities, a county's payment shall be made from
the county's own sources of revenue and payments shall be paid as follows: payments to
the state from the county shall equal 50 percent of the cost of care, as determined by the
commissioner, for each day, or the portion thereof, that the client spends at the facility.
If payments received by the state under sections 246.50 to 246.53 exceed 50 percent of
the cost of care, the county shall be responsible for paying the state only the remaining
amount. The county shall not be entitled to reimbursement from the client, the client's
estate, or from the client's relatives, except as provided in section 246.53.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007.
new text end

Sec. 8.

Minnesota Statutes 2004, section 256B.0625, subdivision 20, is amended to
read:

Subd. 20.

Mental health case management.

(a) To the extent authorized by rule
of the state agency, medical assistance covers case management services to persons with
serious and persistent mental illness and children with severe emotional disturbance.
Services provided under this section must meet the relevant standards in sections 245.461
to 245.4887, the Comprehensive Adult and Children's Mental Health Acts, Minnesota
Rules, parts 9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.

(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe
emotional disturbance when these services meet the program standards in Minnesota
Rules, parts 9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.

(c) Medical assistance and MinnesotaCare payment for mental health case
management shall be made on a monthly basis. In order to receive payment for an eligible
child, the provider must document at least a face-to-face contact with the child, the child's
parents, or the child's legal representative. To receive payment for an eligible adult, the
provider must document:

(1) at least a face-to-face contact with the adult or the adult's legal representative; or

(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact with the adult or the adult's legal representative within
the preceding two months.

(d) Payment for mental health case management provided by county or state staff
shall be based on the monthly rate methodology under section 256B.094, subdivision 6,
paragraph (b), with separate rates calculated for child welfare and mental health, and
within mental health, separate rates for children and adults.

(e) Payment for mental health case management provided by Indian health services
or by agencies operated by Indian tribes may be made according to this section or other
relevant federally approved rate setting methodology.

(f) Payment for mental health case management provided by vendors who contract
with a county or Indian tribe shall be based on a monthly rate negotiated by the host county
or tribe. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the
county or tribe may negotiate a team rate with a vendor who is a member of the team. The
team shall determine how to distribute the rate among its members. No reimbursement
received by contracted vendors shall be returned to the county or tribe, except to reimburse
the county or tribe for advance funding provided by the county or tribe to the vendor.

(g) If the service is provided by a team which includes contracted vendors, tribal
staff, and county or state staff, the costs for county or state staff participation in the team
shall be included in the rate for county-provided services. In this case, the contracted
vendor, the tribal agency, and the county may each receive separate payment for services
provided by each entity in the same month. In order to prevent duplication of services,
each entity must document, in the recipient's file, the need for team case management and
a description of the roles of the team members.

deleted text begin (h) The commissioner shall calculate the nonfederal share of actual medical
assistance and general assistance medical care payments for each county, based on the
higher of calendar year 1995 or 1996, by service date, project that amount forward to 1999,
and transfer one-half of the result from medical assistance and general assistance medical
care to each county's mental health grants under section 256E.12 for calendar year 1999.
The annualized minimum amount added to each county's mental health grant shall be
$3,000 per year for children and $5,000 per year for adults. The commissioner may reduce
the statewide growth factor in order to fund these minimums. The annualized total amount
transferred shall become part of the base for future mental health grants for each county.
deleted text end

deleted text begin (i) Any net increase in revenue to the county or tribe as a result of the change in this
section must be used to provide expanded mental health services as defined in sections
245.461 to 245.4887, the Comprehensive Adult and Children's Mental Health Acts,
excluding inpatient and residential treatment. For adults, increased revenue may also be
used for services and consumer supports which are part of adult mental health projects
approved under Laws 1997, chapter 203, article 7, section 25. For children, increased
revenue may also be used for respite care and nonresidential individualized rehabilitation
services as defined in section 245.492, subdivisions 17 and 23. "Increased revenue" has
the meaning given in Minnesota Rules, part 9520.0903, subpart 3.
deleted text end

deleted text begin (j) deleted text end new text begin (h) new text end Notwithstanding section 256B.19, subdivision 1, the nonfederal share of
costs for mental health case management shall be provided by the recipient's county of
responsibility, as defined in sections 256G.01 to 256G.12, from sources other than federal
funds or funds used to match other federal funds. If the service is provided by a tribal
agency, the nonfederal share, if any, shall be provided by the recipient's tribe. new text begin When this
service is paid by the state without a federal share through fee-for-service, 50 percent of
the cost shall be provided by the recipient's county of responsibility.
new text end

new text begin (i) Notwithstanding Minnesota Rules to the contrary, prepaid medical assistance,
general assistance medical care, and MinnesotaCare include mental health case
management. When the service is provided through prepaid capitation, the nonfederal
share is paid by the state and there is no county share.
new text end

deleted text begin (k) deleted text end new text begin (j) new text end The commissioner may suspend, reduce, or terminate the reimbursement to a
provider that does not meet the reporting or other requirements of this section. The county
of responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal
agency, is responsible for any federal disallowances. The county or tribe may share this
responsibility with its contracted vendors.

deleted text begin (l) deleted text end new text begin (k) new text end The commissioner shall set aside a portion of the federal funds earned new text begin for
county expenditures new text end under this section to repay the special revenue maximization account
under section 256.01, subdivision 2, clause (15). The repayment is limited to:

(1) the costs of developing and implementing this section; and

(2) programming the information systems.

deleted text begin (m) deleted text end new text begin (l) new text end Payments to counties and tribal agencies for case management expenditures
under this section shall only be made from federal earnings from services provided
under this section. new text begin When this service is paid by the state without a federal share through
fee-for-service, 50 percent of the cost shall be provided by the state. new text end Payments to
county-contracted vendors shall include deleted text begin both deleted text end the federal earnings new text begin , the state share, new text end and the
county share.

deleted text begin (n) Notwithstanding section 256B.041, county payments for the cost of mental
health case management services provided by county or state staff shall not be made
to the commissioner of finance. For the purposes of mental health case management
services provided by county or state staff under this section, the centralized disbursement
of payments to counties under section 256B.041 consists only of federal earnings from
services provided under this section. deleted text end

deleted text begin (o) deleted text end new text begin (m) new text end Case management services under this subdivision do not include therapy,
treatment, legal, or outreach services.

deleted text begin (p) deleted text end new text begin (n) new text end If the recipient is a resident of a nursing facility, intermediate care facility,
or hospital, and the recipient's institutional care is paid by medical assistance, payment
for case management services under this subdivision is limited to the last 180 days of
the recipient's residency in that facility and may not exceed more than six months in a
calendar year.

deleted text begin (q) deleted text end new text begin (o) new text end Payment for case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.

deleted text begin (r) By July 1, 2000, the commissioner shall evaluate the effectiveness of the changes
required by this section, including changes in number of persons receiving mental health
case management, changes in hours of service per person, and changes in caseload size.
deleted text end

deleted text begin (s) For each calendar year beginning with the calendar year 2001, the annualized
amount of state funds for each county determined under paragraph (h) shall be adjusted by
the county's percentage change in the average number of clients per month who received
case management under this section during the fiscal year that ended six months prior to
the calendar year in question, in comparison to the prior fiscal year.
deleted text end

deleted text begin (t) For counties receiving the minimum allocation of $3,000 or $5,000 described
in paragraph (h), the adjustment in paragraph (s) shall be determined so that the county
receives the higher of the following amounts:
deleted text end

deleted text begin (1) a continuation of the minimum allocation in paragraph (h); or
deleted text end

deleted text begin (2) an amount based on that county's average number of clients per month who
received case management under this section during the fiscal year that ended six months
prior to the calendar year in question, times the average statewide grant per person per
month for counties not receiving the minimum allocation.
deleted text end

deleted text begin (u) The adjustments in paragraphs (s) and (t) shall be calculated separately for
children and adults.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2008.
new text end

Sec. 9.

Minnesota Statutes 2004, section 256B.0945, subdivision 1, is amended to read:

Subdivision 1.

Provider qualifications.

Counties must arrange to provide
residential services for children with severe emotional disturbance according to sections
245.4882, 245.4885, and this section. Services must be provided by a facility that is
licensed according to section 245.4882 and administrative rules promulgated thereunder,
and under contract with the county. deleted text begin Facilities providing services under subdivision 2,
paragraph (a), must be accredited as a psychiatric facility by the Joint Commission
on Accreditation of Healthcare Organizations, the Commission on Accreditation of
Rehabilitation Facilities, or the Council on Accreditation. Accreditation is not required for
facilities providing services under subdivision 2, paragraph (b). deleted text end

Sec. 10.

Minnesota Statutes 2004, section 256B.0945, subdivision 4, is amended to
read:

Subd. 4.

Payment rates.

(a) Notwithstanding sections 256B.19 and 256B.041,
payments to counties for residential services provided by a residential facility shall only
be made of federal earnings for services provided under this section, and the nonfederal
share of costs for services provided under this section shall be paid by the county from
sources other than federal funds or funds used to match other federal funds. Payment to
counties for services provided according to this section shall be a proportion of the per
day contract rate that relates to rehabilitative mental health services and shall not include
payment for costs or services that are billed to the IV-E program as room and board.

(b) new text begin Per diem rates paid to providers under this section by prepaid plans shall be the
proportion of the per day contract rate that relates to rehabilitative mental health services
and shall not include payment for costs or services that are billed to the IV-E program
as room and board.
new text end

new text begin (c) new text end The commissioner shall set aside a portion not to exceed five percent of the
federal funds earned new text begin for county expenditures new text end under this section to cover the state costs of
administering this section. Any unexpended funds from the set-aside shall be distributed
to the counties in proportion to their earnings under this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2008.
new text end

Sec. 11.

Minnesota Statutes 2004, section 256B.69, subdivision 5g, is amended to read:

Subd. 5g.

Payment for covered services.

For services rendered on or after January
1, 2003, the total payment made to managed care plans for providing covered services
under the medical assistance and general assistance medical care programs is reduced by
.5 percent from their current statutory rates. This provision excludes payments for nursing
home services, home and community-based waivers, deleted text begin and deleted text end payments to demonstration
projects for persons with disabilities new text begin , and mental health services added as covered benefits
after December 31, 2006 new text end .

Sec. 12.

Minnesota Statutes 2004, section 256B.69, subdivision 5h, is amended to read:

Subd. 5h.

Payment reduction.

In addition to the reduction in subdivision 5g,
the total payment made to managed care plans under the medical assistance program is
reduced 1.0 percent for services provided on or after October 1, 2003, and an additional
1.0 percent for services provided on or after January 1, 2004. This provision excludes
payments for nursing home services, home and community-based waivers, deleted text begin and deleted text end payments
to demonstration projects for persons with disabilities new text begin , and mental health services added as
covered benefits after December 31, 2006 new text end .

Sec. 13.

new text begin [256B.763] CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.
new text end

new text begin (a) For services defined in paragraph (b) and rendered on or after July 1, 2007,
payment rates shall be increased by 23.7 percent over the rates in effect on January 1,
2006, for:
new text end

new text begin (1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;
new text end

new text begin (2) community mental health centers under section 256B.0625, subdivision 5; and
new text end

new text begin (3) mental health clinics and centers certified under Minnesota Rules, parts
9520.0750 to 9520.0870, or hospital outpatient psychiatric departments that are designated
as essential community providers under section 62Q.19.
new text end

new text begin (b) This increase applies to group skills training when provided as a component of
children's therapeutic services and support, psychotherapy, medication management,
evaluation and management, diagnostic assessment, explanation of findings, psychological
testing, neuropsychological services, direction of behavioral aides, and inpatient
consultation.
new text end

new text begin (c) This increase does not apply to rates that are governed by sections 256B.0625,
subdivision 30, and 256B.761, paragraph (b), other cost-based rates, rates that are
negotiated with the county, rates that are established by the federal government, or rates
that increased between January 1, 2004, and January 1, 2005.
new text end

new text begin (d) The commissioner shall adjust rates paid to prepaid health plans under contract
with the commissioner to reflect the rate increases provided in paragraph (a). The prepaid
health plan must pass this rate increase to the providers identified in paragraph (a).
new text end

Sec. 14.

Minnesota Statutes 2005 Supplement, section 256D.03, subdivision 4, is
amended to read:

Subd. 4.

General assistance medical care; services.

(a)(i) For a person who is
eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):

(1) inpatient hospital services;

(2) outpatient hospital services;

(3) services provided by Medicare certified rehabilitation agencies;

(4) prescription drugs and other products recommended through the process
established in section 256B.0625, subdivision 13;

(5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;

(6) eyeglasses and eye examinations provided by a physician or optometrist;

(7) hearing aids;

(8) prosthetic devices;

(9) laboratory and X-ray services;

(10) physician's services;

(11) medical transportation except special transportation;

(12) chiropractic services as covered under the medical assistance program;

(13) podiatric services;

(14) dental services as covered under the medical assistance program;

(15) deleted text begin outpatient services provided by a mental health center or clinic that is under
contract with the county board and is established under section 245.62 deleted text end new text begin mental health
services covered under chapter 256B new text end ;

deleted text begin (16) day treatment services for mental illness provided under contract with the
county board;
deleted text end

deleted text begin (17) deleted text end new text begin (16) new text end prescribed medications for persons who have been diagnosed as mentally
ill as necessary to prevent more restrictive institutionalization;

deleted text begin (18) psychological services, deleted text end new text begin (17) new text end medical supplies and equipment, and Medicare
premiums, coinsurance and deductible payments;

deleted text begin (19) deleted text end new text begin (18) new text end medical equipment not specifically listed in this paragraph when the use
of the equipment will prevent the need for costlier services that are reimbursable under
this subdivision;

deleted text begin (20) deleted text end new text begin (19) new text end services performed by a certified pediatric nurse practitioner, a
certified family nurse practitioner, a certified adult nurse practitioner, a certified
obstetric/gynecological nurse practitioner, a certified neonatal nurse practitioner, or a
certified geriatric nurse practitioner in independent practice, if (1) the service is otherwise
covered under this chapter as a physician service, (2) the service provided on an inpatient
basis is not included as part of the cost for inpatient services included in the operating
payment rate, and (3) the service is within the scope of practice of the nurse practitioner's
license as a registered nurse, as defined in section 148.171;

deleted text begin (21) deleted text end new text begin (20) new text end services of a certified public health nurse or a registered nurse practicing
in a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section 148.171; new text begin and
new text end

deleted text begin (22) deleted text end new text begin (21) new text end telemedicine consultations, to the extent they are covered under section
256B.0625, subdivision 3b deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (23) mental health telemedicine and psychiatric consultation as covered under
section 256B.0625, subdivisions 46 and 48.
deleted text end

(ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
to inpatient hospital services, including physician services provided during the inpatient
hospital stay. A $1,000 deductible is required for each inpatient hospitalization.

(b) Effective August 1, 2005, sex reassignment surgery is not covered under this
subdivision.

(c) In order to contain costs, the commissioner of human services shall select
vendors of medical care who can provide the most economical care consistent with high
medical standards and shall where possible contract with organizations on a prepaid
capitation basis to provide these services. The commissioner shall consider proposals by
counties and vendors for prepaid health plans, competitive bidding programs, block grants,
or other vendor payment mechanisms designed to provide services in an economical
manner or to control utilization, with safeguards to ensure that necessary services are
provided. Before implementing prepaid programs in counties with a county operated or
affiliated public teaching hospital or a hospital or clinic operated by the University of
Minnesota, the commissioner shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to participate in the program in a
manner that reflects the risk of adverse selection and the nature of the patients served by
the hospital, provided the terms of participation in the program are competitive with the
terms of other participants considering the nature of the population served. Payment for
services provided pursuant to this subdivision shall be as provided to medical assistance
vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
payments made during fiscal year 1990 and later years, the commissioner shall consult
with an independent actuary in establishing prepayment rates, but shall retain final control
over the rate methodology.

(d) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
co-payments for services provided on or after October 1, 2003:

(1) $25 for eyeglasses;

(2) $25 for nonemergency visits to a hospital-based emergency room;

(3) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness; and

(4) 50 percent coinsurance on restorative dental services.

(e) Co-payments shall be limited to one per day per provider for nonpreventive visits,
eyeglasses, and nonemergency visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all co-payments in this subdivision.
The general assistance medical care reimbursement to the provider shall be reduced by
the amount of the co-payment, except that reimbursement for prescription drugs shall not
be reduced once a recipient has reached the $12 per month maximum for prescription
drug co-payments. The provider collects the co-payment from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment, except as
provided in paragraph (f).

(f) If it is the routine business practice of a provider to refuse service to an individual
with uncollected debt, the provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient with uncollected debt before
services can be denied.

(g) Any county may, from its own resources, provide medical payments for which
state payments are not made.

(h) Chemical dependency services that are reimbursed under chapter 254B must not
be reimbursed under general assistance medical care.

(i) The maximum payment for new vendors enrolled in the general assistance
medical care program after the base year shall be determined from the average usual and
customary charge of the same vendor type enrolled in the base year.

(j) The conditions of payment for services under this subdivision are the same as the
conditions specified in rules adopted under chapter 256B governing the medical assistance
program, unless otherwise provided by statute or rule.

(k) Inpatient and outpatient payments shall be reduced by five percent, effective July
1, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph (i).

(l) Payments for all other health services except inpatient, outpatient, and pharmacy
services shall be reduced by five percent, effective July 1, 2003.

(m) Payments to managed care plans shall be reduced by five percent for services
provided on or after October 1, 2003.

(n) A hospital receiving a reduced payment as a result of this section may apply the
unpaid balance toward satisfaction of the hospital's bad debts.

(o) Fee-for-service payments for nonpreventive visits shall be reduced by $3
for services provided on or after January 1, 2006. For purposes of this subdivision, a
visit means an episode of service which is required because of a recipient's symptoms,
diagnosis, or established illness, and which is delivered in an ambulatory setting by
a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
audiologist, optician, or optometrist.

(p) Payments to managed care plans shall not be increased as a result of the removal
of the $3 nonpreventive visit co-payment effective January 1, 2006.

new text begin (q) Payments for mental health services added as covered benefits after December
31, 2006, are not subject to the reductions in paragraphs (i), (k), (l), and (m).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007, except mental
health case management under paragraph (a)(i)(15) is effective January 1, 2008.
new text end

Sec. 15.

Minnesota Statutes 2005 Supplement, section 256L.03, subdivision 1, is
amended to read:

Subdivision 1.

Covered health services.

For individuals under section 256L.04,
subdivision 7, with income no greater than 75 percent of the federal poverty guidelines
or for families with children under section 256L.04, subdivision 1, all subdivisions of
this section apply. "Covered health services" means the health services reimbursed
under chapter 256B, with the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care services other than services
covered under section 256B.0625, subdivision 9, orthodontic services, nonemergency
medical transportation services, personal care assistant and case management services,
nursing home or intermediate care facilities services, inpatient mental health services,
and chemical dependency services. deleted text begin Outpatient mental health services covered under the
MinnesotaCare program are limited to diagnostic assessments, psychological testing,
explanation of findings, mental health telemedicine, psychiatric consultation, medication
management by a physician, day treatment, partial hospitalization, and individual, family,
and group psychotherapy.
deleted text end

No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007, except mental
health case management under subdivision 1 is effective January 1, 2008.
new text end

Sec. 16.

Minnesota Statutes 2005 Supplement, section 256L.035, is amended to read:

256L.035 LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE
ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.

(a) "Covered health services" for individuals under section 256L.04, subdivision
7, with income above 75 percent, but not exceeding 175 percent, of the federal poverty
guideline means:

(1) inpatient hospitalization benefits with a ten percent co-payment up to $1,000 and
subject to an annual limitation of $10,000;

(2) physician services provided during an inpatient stay; and

(3) physician services not provided during an inpatient stay; outpatient hospital
services; freestanding ambulatory surgical center services; chiropractic services; lab and
diagnostic services; diabetic supplies and equipment; new text begin mental health services as covered
under chapter 256B; new text end and prescription drugs; subject to the following co-payments:

(i) $50 co-pay per emergency room visit;

(ii) $3 co-pay per prescription drug; and

(iii) $5 co-pay per nonpreventive visit.

The services covered under this section may be provided by a physician, physician
ancillary, chiropractor, psychologist, deleted text begin or deleted text end licensed independent clinical social worker new text begin , or
other mental health providers covered under chapter 256B new text end if the services are within the
scope of practice of that health care professional.

For purposes of this section, "a visit" means an episode of service which is required
because of a recipient's symptoms, diagnosis, or established illness, and which is delivered
in an ambulatory setting by any health care provider identified in this paragraph.

Enrollees are responsible for all co-payments in this section.

(b) Reimbursement to the providers shall be reduced by the amount of the
co-payment, except that reimbursement for prescription drugs shall not be reduced once a
recipient has reached the $20 per month maximum for prescription drug co-payments.
The provider collects the co-payment from the recipient. Providers may not deny services
to recipients who are unable to pay the co-payment, except as provided in paragraph (c).

(c) If it is the routine business practice of a provider to refuse service to an individual
with uncollected debt, the provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient with uncollected debt before
services can be denied.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007, except mental
health case management under paragraph (a), clause (3), is effective January 1, 2008.
new text end

Sec. 17.

Minnesota Statutes 2004, section 256L.12, subdivision 9a, is amended to read:

Subd. 9a.

Rate setting; ratable reduction.

For services rendered on or after
October 1, 2003, the total payment made to managed care plans under the MinnesotaCare
program is reduced 1.0 percent. new text begin This provision excludes payments for mental health
services added as covered benefits after December 31, 2006.
new text end

Sec. 18. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin In the next edition of Minnesota Statutes, the revisor of statutes shall change the
reference to sections 245.487 to 245.4887, the Children's Mental Health Act, wherever it
appears in statutes or rules to sections 245.487 to 245.4889.
new text end

Sec. 19. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, sections 245.465, subdivision 2; 256B.0945, subdivisions
5, 6, 7, 8, and 9; and 256B.83, new text end new text begin are repealed.
new text end